Acute myocardial infarction (AMI), also known as myocardial infarction, is caused bycoronary arteryAcute obstruction leads to the insufficiency of blood supply in the corresponding myocardial area, which causes myocardial necrosis and affects life.The disease is mainly caused byatherosclerosis、Arrhythmia、respiratory failureInsufficient blood supply caused by various reasonsMyocardial hypoxiaAnd excessive oxygen consumption of myocardium.Globally, the incidence and mortality of acute myocardial infarction are high, and middle-aged and elderly people, people with heart disease, smokingdiabetesandHyperlipidemiaAnd other high-risk groups.According to its pathogenesis, acute myocardial infarction is often divided into five types.
The main symptoms of acute myocardial infarction include cardiac ischemia symptoms, such as chest pain or suffocation, which lasts for more than 30 minutes. Patients often have a sense of dying.In the early stage of pain attack, patients may also have chest tightness, shortness of breath, cough and other heart failure symptoms, and in severe cases may have shock symptoms.Acute myocardial infarction (AMI) is a non infectious disease, which is mainly caused by cardiovascular diseases and other primary diseases.
The main goal of acute myocardial infarction treatment is to dredge the coronary artery immediately and slow down the progress of myocardial ischemia and myocardial infarction.Common treatment methods include medication, such asAntiplatelet agents, anticoagulants, lipid-lowering drugs, and interventional therapy and surgical treatment such as percutaneous coronary intervention, emergency coronary artery bypass grafting, etc.The main way to prevent myocardial infarction is to control the risk factors of heart disease such as hypertension, diabetes, hyperlipidemia, and maintain a reasonable lifestyle, such as smoking cessation, moderate exercise, balanced diet, etc.The prognosis of acute myocardial infarction varies with many factors, such as the timeliness of treatment, the extent of ischemic myocardium, etc.
In recent years, researchers are exploring cutting-edge technologies such as stem cell therapy to repair myocardial function after acute myocardial infarction, but it is still in the experimental research stage.
atherosclerosisIt is the most common cause of acute myocardial infarction.But previous heart disease, smokingdiabetes、Dyslipidemia, overweight or obesity, unreasonable diet, emotional excitement, weather changes may be the cause of acute myocardial infarction.
Pathogenesis
The cause of acute myocardial infarction is that the blood supply channel of the heart itself is blocked due to various reasons, and the myocardium without blood supply still works, and the oxygen consumption continues to increase, which leads to the imbalance of oxygen supply and demand, leading to myocardial necrosis.To sum up, the etiology of acute myocardial infarction is mainly reflected in the following three aspects.
Decreased blood perfusion in the heart
The blood supply of some branches of the coronary artery is reduced due to various reasons, and the myocardial blood supply is insufficient, thus causing the imbalance between supply and demand of myocardial oxygen.
Common causes of decreased perfusion include coronary atherosclerosisCoronary spasm, coronary microcirculation dysfunctionCoronary embolismCoronary artery dissection.
Insufficient myocardial oxygen supply
In addition to the possibility of insufficient blood perfusion,Bradyarrhythmia、respiratory failure, severe anemiahypotension、shockAll of them can cause insufficient myocardial oxygen supply.If the myocardial hypoxia is serious, the hypoxia area may be damaged and necrotic due to hypoxia.
Increased myocardial oxygen consumption
If sustained tachyarrhythmia, severe hypertension, etc., the myocardial oxygen consumption exceeds the oxygen supply, and the myocardial may be damaged due to overwork.
Predisposing factors
There are many inducing factors of acute myocardial infarction, and any factor inducing thrombosis, vascular plaque shedding, coronary artery spasm or stenosis can cause disease.
Common inducements in daily life include: strenuous exercise, excessive fatigue, overeating, mood fluctuations, weather changes, constipation, forced defecation, etc.
symptom
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The main symptom of patients with acute myocardial infarction is a sudden attack of precordial squeezing pain or suffocation lasting more than 30 minutes, and patients often feel dying.
a precursor
Some patients may have fatigue, chest discomfort, palpitations, shortness of breath, irritability, precordial pain and other common symptoms of coronary heart disease a few days before onset.
early symptom
The precordial pain is often the earliest symptom of acute myocardial infarction, which is often seen in the morning. It may occur during rest or activity, and can be manifested as prolonged non relief.
There are also a few patients who have no pain. They have heart failure symptoms such as chest tightness, shortness of breath, dyspnea, cough, or shock symptoms such as vague consciousness, pale skin, cold limbs, sweating all over the body, and low blood pressure.
Typical symptoms
The typical symptoms of the disease are precordial pain or suffocation.Pain or suffocation mainly refers to the back of the sternum, which can extend to the left rib, epigastrium and the left shoulder, back and even mouth and head.Some patients can also show in the left upper limb.
The nature of pain is mostly "pressure, squeezing and heaviness" in the precordial area.Some patients have no obvious sensation in the chest, only dull pain or discomfort in other parts of the chest.
Pain lasts for a long time, more than 30 minutes, no obvious pain peak, rest quietly or applyglyceryl trinitrateAnd other drugs can not quickly alleviate symptoms.
Accompanying symptoms
After the occurrence of acute myocardial infarction, blood pressure, heart rate and heart rhythm may change to varying degrees.
At the initial stage, the myocardial perfusion was reduced, and the oxygen supply was insufficient. The heart tried to improve the hypoxia by increasing the blood supply of the whole body, so the patient had a faster heartbeat and higher blood pressure.
In the later stage, the above methods failed to effectively improve the myocardial oxygen supply, and the increased oxygen consumption caused by the ineffective work of the myocardium led to an increase in the number of ischemic and necrotic myocardium, a gradual decline in cardiac function, and obstacles in the heart and blood circulation throughout the body, accompanied by slow heartbeat, sweating, dyspnea, dizziness, confusion and other manifestations.
Some patients may have direct shock.
Medical treatment
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In case of sudden chest pain, shoulder and back pain, epigastric pain, dizziness, nausea and other symptoms in patients without previous heart disease or known heart disease, they can take 1 nitroglycerin tablet or 10 quick acting heart saving pills sublingually.After 5-10 minutes, if the above symptoms are not significantly relieved, call 120 for emergency immediately.
After dialing the emergency call, you can chew aspirin as required by the medical staff and wait for the ambulance to arrive.During waiting for help, keep yourself quiet as much as possible, and do not walk or drive frequently.
Diagnostic process
After arriving at the hospital, the emergency department or cardiology department will receive the patient, measure the vital signs such as blood pressure, heart rate and respiration, and complete the ECG examination. At the same time, the nurse will take blood, including the laboratory examination of heart markers.
While waiting for the results, if the ECG and medical history can be clearly diagnosed and the conditions of both doctors and patients allow, the patient enters the cardiac catheterization room for emergency percutaneous coronary intervention.
If the diagnosis cannot be made clearly, it is necessary to recheck the ECG every 30~60 minutes to understand the changes of the condition until the laboratory inspection report is completed. The dynamic observation of cardiac biomarkers, mainly troponin, is also an important basis for excluding or diagnosing acute myocardial infarction.
If the examination results can make a clear diagnosis, enter the cardiac catheterization room for interventional treatment or thrombolytic therapy according to the conditions of both doctors and patients.If the diagnosis cannot be made clearly, continue the ECG and cardiac marker examination, and carry out other examinations if necessary.
Cardiac markers: especiallycardiac troponin (cTn) rises above the 99th percentile of the normal upper limit.
Evidence of myocardial ischemia: symptoms of myocardial ischemia, new ischemic ECG changes, new occurrencePathological Q wave、Coronary angiographyImaging examination showed that the newly found report was consistent with this ischemia.
Visiting department
Emergency department or cardiology department.
Relevant inspection
During diagnosis and treatment, ECG and cardiac markers often need to be checked repeatedly.
ECG examination
It can indicate cardiac ischemia, but can only be qualitative, not quantitative.According to the analysis of multiple ECG differences, that is, dynamic changes, we can understand the trend of cardiac ischemia, the extent of myocardial infarction, and evaluate the efficacy.
Cardiac marker examination
The serological examination used to reflect cardiac function, cardiovascular inflammation, and cardiac tissue damage can, to a certain extent, indicate the degree of myocardial infarction.
Coronary angiography
It can provide detailed vascular information, which is helpful to guide treatment and evaluate prognosis.
Other inspections
For example, echocardiography, radionuclide scanning, cardiac perfusion scanning, etc. can be used to evaluate myocardial perfusion, myocardial viability and function to a certain extent.
Orthopedic diseases such as intercostal neuralgia and costochondritis also have the performance of precordial pain, but the pain is more persistent than paroxysmal, and the pain is aggravated when breathing hard, coughing, holding breath, and turning the body.According to the above pain properties and drug treatment effects can be identified.
The nature of pain is mostly persistent, radiating backward, patients often have elevated blood pressure at the onset of the disease, and myocardial infarction may occur when the dissection involves the coronary artery. Due to different treatment principles and methods, rapid identification is needed.
treatment
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The primary purpose of the treatment of acute myocardial infarction is to dredge the blocked coronary artery timely and restore the function of ischemic and hypoxic myocardium.Generally, it is beneficial to the recovery of patients from two aspects: expanding coronary artery and eliminating pathogenic blockages, while reducing cardiac load, such as oxygen inhalation, absolute bed rest, and avoiding emotional fluctuations.
Acute treatment
At present, all secondary or above hospitals have opened a green channel for acute myocardial infarction rescue.Although the treatment conditions of each hospital are different, they all strive to make a clear diagnosis and timely treatment in the shortest time.The usual treatment options include percutaneous coronary intervention, thrombolysis, and emergency surgical bypass surgery.
General treatment
Absolute bed rest
Reduce the heart load, and the patients without complications can get down to the ground properly after 3 days.
Keep a relatively quiet environment
Reduce external stimulation, so that patients can have a full rest without being disturbed.
Monitor the condition
For example, monitor vital signs, including blood pressure, respiration, pulse, heart rate, recheck ECG, cardiac markers, etc., and timely understand the changes in the condition.
Oxygen inhalation
To some extent, it can alleviate myocardial hypoxia.
asglyceryl trinitrateIt is suitable for most patients with acute myocardial infarction, and should be used cautiously for those with obvious hypotension.
Drugs for reducing myocardial oxygen consumption
asmetoprolol、BisoprololIt should be used with caution for patients with low blood pressure and slow heart rate, and patients with acute cardiac insufficiency.
High risk patients with significantly elevated blood lipids can also usePCSK9 inhibitorIn the long term, it can delay the progress of coronary atherosclerosis and avoid the recurrence of acute myocardial infarction.
Thrombolytic drugs
The thrombolysis of embolic blood vessels must be applied under the close supervision of the hospital.
It is suitable for patients with clear ECG signs within 12 hours after the onset of symptoms.It needs to be treated by experienced doctors in hospitals with cardiac catheterization rooms.
According to the obstruction, balloon angioplasty and stent implantation are performed after intervention. Although the overall treatment cost is relatively high, compared with thrombolytic therapy, interventional therapy has a higher vascular patency rate, wider indications, and fewer bleeding complications. Therefore, for patients with acute myocardial infarction, it is recommended to give priority to interventional therapy.
Emergency coronary artery bypass grafting
It is used for patients with failure of interventional therapy or ineffective thrombolytic therapy, or patients with mechanical complications requiring surgical correction.The operation is complicated and traumatic, and the corresponding risks associated with the operation are also large.
TCM treatment
In the treatment of acute myocardial infarction, TCM takes the principle of restoring yang to rescue the adverse, promoting blood circulation and removing blood stasis as the treatment principle. The drugs commonly used in prescriptions aremonkshood、Salvia miltiorrhiza、safflower、GinsengAnd other drugs.However, during the period of acute myocardial infarction, the condition is critical, and it is generally not recommended to choose TCM treatment.
Frontier treatment
Stem cell therapy is used to repair myocardial function after infarction, which is still in the stage of laboratory research.
prognosis
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The prognosis of acute myocardial infarction is usually related to the extent of myocardial infarction, whether other blood supply routes are established at the infarction site, and whether the treatment is timely and effective.
The case fatality rate of thrombolytic therapy is about 8%, and that of interventional therapy is about 4%.Patients with simple myocardial infarction can resume normal life if they are treated in time and effectively.
If complications occur during acute myocardial infarction, the complications may last for a long time after improvement.If there are other diseases in the past, especially those with cardiovascular and cerebrovascular diseases, the risk of death will increase accordingly, and the prognosis will be poor.
Curative
Acute myocardial infarction (AMI) is a stage of myocardial ischemia and necrosis caused by severe coronary atherosclerotic heart disease (CHD). At this stage, there is no effective treatment to recover the necrotic myocardium, and because the cause of CHD cannot be cured, AMI cannot actually be "cured", and patients have the risk of myocardial infarction again.
For this disease, the main goal of treatment is to actively cooperate with doctors to treat, alleviate symptoms and control the progress of the disease.
harmfulness
It can induce malignant arrhythmia such as ventricular fibrillation and cardiac rupture, leading to death of patients;
If the papillary muscle is involved in the infarction, it can cause mitral valve prolapse and insufficiency, and then cause heart failure, which can lead to patient death;
It can cause ventricular mural thrombus to fall off and cause multiple organ embolism, which can lead to death in serious cases;
Losing function of necrotic myocardium may leave cardiac insufficiency and various arrhythmias, affecting the quality of life of patients;
It can cause myocardial thinning, and bulge into ventricular aneurysm under blood pressure, which can lead to cardiac insufficiency, thromboembolism and arrhythmia.
recovery
For patients with acute myocardial infarction, individualized cardiac rehabilitation plans, including diet and exercise, will be developed according to the infarct size and cardiac function, which will help patients recover their functions as soon as possible.
complication
When acute myocardial infarction attacks, it often induces changes in multiple organs of the whole body, accompanied by one or more disease manifestations, such as arrhythmia, heart failure and other heart diseases often appear in the form of complications in the onset of acute myocardial infarction.
Due to the occurrence of acute myocardial infarction, the myocardial innervated by the infarction site can not work normally, and the normal cardiac contraction rhythm changes, resulting in arrhythmia.Serious arrhythmias cause abnormal blood supply function of the whole body, thus endangering life.
Myocardium outside the infarct site can not pump blood effectively due to excessive post infarction load, large area of loss of function, and the whole body blood can not circulate effectively, endangering life.
Due to abnormal heart function, systemic circulation disorder, blood can not be effectively transmitted to the whole body, and multiple organs are suffering from ischemia and hypoxia, which is an inevitable stage of death caused by acute myocardial infarction.Once it happens, even if medical personnel try their best to rescue, there is still a great possibility of death.
For the public andcoronary heart diseasePatients should popularize the knowledge about myocardial infarction to prevent the occurrence of myocardial infarction. If it happens, it can be diagnosed early and treated in time.In addition to the above contents of secondary prevention, the following points should also be noted in daily life:
Do not bathe with a full meal or hunger.The water temperature should be the same as the body temperature, and the bathing time should not be too long. Patients with severe coronary heart disease should be bathed with the help of others.
Watch out for climate change
In severe cold or strongcold airUnder the influence,coronary arterySpasm may occur and induce acute myocardial infarction.Therefore, in case of severe weather, patients with coronary heart disease should pay attention to keeping warm or proper protection.
Understand and recognize the premonitory symptoms of myocardial infarction and give timely treatment
About 70% of patients with myocardial infarction have premonitory symptoms, mainly as follows:
None in the pastangina pectorisSudden occurrence of patientsangina pectoris, or the attack of patients with original angina suddenly and significantly aggravated, or spontaneous attack without incentives;
The nature of angina pectoris is changed and the time is longer than before. Nitroglycerin is not easy to relieve;
Pain accompanied by nausea, vomiting, sweating or obviousBradycardiaOr over speed;
Angina pectoris attacks with shortness of breath and dyspnea;
Sudden arrhythmia, heart failure, shock orsyncopeThe possibility of myocardial infarction should be considered in all cases.
Once the above symptoms occur, they must be taken seriously. The patient should first stay in bed, keep quiet, and avoidMental overstrain；Sublingual clothingNitroglycerin or spray inhalationglyceryl trinitrate, if not relieved, another tablet can be taken after 5 minutes.Go to the hospital after angina pectoris is relieved.ifChest painIf there is no relief or severe chest pain with nausea, vomiting, dyspnea and syncope within 20 minutes, callambulanceSend to hospital.
